PTA及血管内支架治疗下肢多节段动脉硬化闭塞症的应用  

STUDY OF PTA AND STENTING FOR THE TREATMENT OF MULTI-SEGMENTAL ATHEROSCLEROTIC OCCLUSIVE LOWER LIMBS

作　　者：黄新天[1] 蒋米尔[1] 陆民[1] 朱雯霞[1] 李维敏[1] 黄英[1] 陆信武[1] 张培华[1] 

机构地区：[1]上海第二医科大学附属第九人民医院血管外科,上海200011

出　　处：《中国现代普通外科进展》1999年第4期34-36,共3页Chinese Journal of Current Advances in General Surgery

摘　　要：目的 探讨经皮腔内球囊扩张血管成形术及血管内支架治疗下肢多节段动脉硬化闭塞症的临床应用价值.方法 全组11例,共18条患肢(闭塞病变22个节段).15段闭塞长度在7cm以内者作PTA,病灶分别位于髂总动脉6段、器外动脉2段、股浅动脉7段;15段中有4段与PTA同时置入血管内支架.另外长段闭塞的7段,于短段作PTA同时或在术后1周内作动脉重建术,其中腹主-股总动脉转流术1段、腹主-股深动脉1段、股-腘动脉3段、腘动脉间置移植术1段、股深动脉成形术1段.结果 1条患肢因PTA失败即改作转流术,2条患肢术后并发股浅动脉急性栓塞,作取栓治疗后,均恢复血循环.术后近期内,全组18条患肢临床症状改善,其中16条末梢动脉搏动恢复,踝/肱指数由术前0.54±0.11增高至0.79±0.15.随访6～72个月后,2条作PTA患肢的股浅动脉分别于1年和5年后再次闭塞.结论 经皮腔内球囊扩张血管成形术是治疗下肢动脉闭塞性疾病的有效方法,血管内支架置放有助于提高通畅率,多节段动脉闭塞性病变联合手术重建,可简化手术操作,缩小手术创伤.Objective:To evaluate the effects of PTA and stent implantation for thetreatment of multisegmental atherosclerotic occlusive lower limbs. Methods: Fifteen limbs were treated using percutaneous transluminal angioplasty(PTA), including 6 common iliac arteries,2 external iliac arteries,7 superficial femoral arteries.Four limbs were inserted stent in iliac artery after PTA. Seven patients with severe multi-segmental occlusive disease were managed by PTA with simultaneous surgical revascularizat'ion. Results : 18 limbs had excellent results with disappearance of symptoms and recovery of distal artery pulsation in 16 limbs. Pre-treatment ankle/brachial index of 0. 54 ±0. 1 increased to 0.79 ±0.15 after PTA. Arterial thromboembolization was found in 2 limbs, and PTA failed in 1 limb, which was transfered to surgical reconstruction. The follow-up period ranges from 6 to 72 months, all except two limbs with re-obstruction after 1, 5 year re- spectively, were in excellent results. Conclusion: PTA is an effective method for managing the patients with atherosclerotic occlusive disease. The stent insertion can prevent re-obstrution due to elastic recoil of the vessel.Combination of PTA and surgical revascu-larization can be recommended in high-risk patients with severe multi-segmental atherosclerotic lesions.

关 键 词：血管成形术 气囊 动脉硬化闭塞症 PTA 下肢 血管内支架治疗 

分 类 号：R543.5[医药卫生—心血管疾病] R654.3[医药卫生—内科学]